Endoscopic handling of post surgical female ureteral injuries

ABSTRACT

This study included 13 female patients with post-gynecologic [7] or post-obstetric ureteral [6] injuries. The diagnosis of ureteral injury was confirmed by clinical and radiological evaluation. Endoscopic correction was tried either by retrograde or antegrade approach. Ureteral injury was bilateral in four patients and unilateral in nine patients. Five patients presented in the same day of surgery, two of them were reoperated in the same day. Bilateral ureteral injury was corrected surgically in both of them. In the remaining three patients the general condition did not allow for reexploration. Retrograde pyelogram revealed hyper-angulation of the ureter in two and stenting was feasible in both of them. Complete ureteral obstruction was encountered in the third patient and PCN tube was placed. Eight patients presented few days after surgery. Retrograde pyelogram revealed complete obstruction in four patients, for whom PCN tube was placed as a temporary measure to save the renal units. Later on, antegrade studies were performed and surgical correction was done accordingly. In two patients the ureter was incompletely enclosed in sutures, those were handled ureteroscopically using the holmium YAG laser the sutures were fulgurated and the suture material was retrieved by three pronged grasper and stents were placed. In another patient with relative narrowing of the ureteral lumen balloon dilation and stent placement was done. In the last patient angulation was encountered and stent was successfully placed